Most Say They’re Healthy—But Demographic Disparities Loom Large

CalIifornians Want More Emphasis On Prevention, Universal Care For Kids

SAN FRANCISCO, February 9, 2011—Californians have generally positive views of their health, with eight in 10 characterizing it as good to excellent. Most residents rate community conditions that contribute to their health—particularly grocery stores and restaurants—as good or excellent. And most are at least somewhat satisfied with the quality of health care they receive. But there are stark differences in the way key demographic groups view their health and the quality of life in their communities. These are among the key findings of a survey released today by the Public Policy Institute of California (PPIC) with support from The California Endowment.

This is PPIC’s first survey to look extensively at attitudes about health care and the factors that determine the overall health of a community. It was conducted at a time of intense debate—over the national reform law passed last year, over significant statewide cuts in health and human services, and over rising health care costs and service delivery issues at all levels of government.

When asked to weigh in on health policy issues, most Californians say that health care services in their local communities should put more emphasis on prevention than treatment and nearly all say universal health care for children is important in preventing illness.

“As Californians and governments at all levels struggle with health care costs and the prospect of cuts in services, most residents view prevention as important, and they see that local conditions can indeed make a difference in their health,” says Mark Baldassare, PPIC CEO and survey director.

When residents are asked whether the health services in their communities have the right balance between treatment and prevention, 60 percent want more emphasis on prevention, 13 percent want more emphasis on treatment, and 21 percent say the balance is right. Across regions and demographic groups, majorities want more emphasis on prevention. But across political lines, Democrats (67%) and independents (63%) are far more likely than Republicans (44%) to want more emphasis on prevention.

There is more consensus on universal health care for children: nearly all (91%) say it is very important (76%) or somewhat important (15%) in preventing illness. Across all parties, regions, and demographic groups, more than eight in 10 consider it to be at least somewhat important in preventing illness.

HALF SUPPORT NATIONAL HEALTH CARE REFORM LAW

On national health care reform, Californians (51%, 36% oppose) are slightly more likely than adults nationwide (45%, 50% opposed in a recent ABC News/Washington Post poll) to support the law enacted by Congress and President Obama last year.

Californians are also much more likely to view obesity as a very serious public health problem. While 75 percent hold this view, 57 percent of adults nationwide do, according to a December 2009 CBS News poll. California adults differ by political party about how the issue should be addressed. Most Democrats (62%) say it is both an individual and government responsibility, while most Republicans (63%) say it is an individual responsibility. The vast majority of Californians (87%) say a person’s weight can greatly improve chances for a long and healthy life and 10 percent say weight can improve those chances a little.

When it comes to the state’s health care system, most Californians think major changes (59%) or minor changes (24%) are needed, while just 11 percent say the system is basically fine as it is. Those who are uninsured (69%) are more likely than those with health insurance (57%) to say that major changes are needed. A vast majority are concerned (53% very, 31% somewhat) that the state’s budget gap will cause significant spending cuts to health and human services.

WEALTHIER SAY THEY’RE HEALTHIER

A plurality of Californians (46%) say their health is excellent (22%) or very good (24%), while 35 percent call their health good. Far fewer characterize their health as only fair (13%) or poor (5%). But dramatic differences emerge across key groups.

Income. Among Californians in households earning $80,000 or more, 70 percent say their health is very good or excellent compared with 48 percent of middle-income residents and just 31 percent of those in households making less than $40,000.

Education level. Of college graduates, 67 percent rate their health as very good or excellent compared to 56 percent of those with some college education, and 28 percent of those with a high school education or less.

Racial or ethnic group. A majority of whites (58%) say they are in very good or excellent health, while less than half of Asians (45%), 38 percent of blacks, and 31 percent of Latinos say the same.

Health insurance status. Half (51%) of those with health insurance say their health is excellent or very good. Just 31 percent of those without insurance rate their health this way.

MAYBE MONEY CAN BUY HAPPINESS

How happy are Californians with their lives? Nearly eight in 10 are very happy (32%) or pretty happy (47%) with things in their lives these days. One in five (20%) are not too happy. Again, differences across income groups emerge. Just 25 percent of lower-income residents are very happy, compared to 31 percent of middle-income residents and 41 percent of upper-income residents. The percentage saying they are very happy increases slightly with education. Whites (37%) are more likely than blacks (29%), Latinos (27%), and Asians (25%) to be very happy. Among U.S.-born citizens, 34 percent are very happy, as are 30 percent of naturalized citizens and 23 percent of immigrants who are not citizens.

Most adults are very satisfied (40%) or somewhat satisfied (35%) with the quality of their health care, and 22 percent are dissatisfied. Satisfaction increases with income, education, and age. Among whites, 51 percent are very satisfied. Fewer blacks (37%), Latinos (30%), and Asians (27%) say the same.

When asked about the quality of life in their local community, most residents are very satisfied (36%) or somewhat satisfied (44%), and 19 percent are dissatisfied. Upper-income residents (53%) are far more likely to be very satisfied than those who are middle (33%) and lower (26%) income.

HIGH MARKS FOR LOCAL SERVICES, AMENITIES

Californians generally give good or excellent ratings to their local grocery stores and restaurants (86%), parks and playgrounds (79%), police protection (78%), medical and health care services (72%), public schools (59%), and roads and sidewalks (54%). Across parties, regions, and demographic groups each service gets a positive rating from about half or more residents.

Among the services residents were asked to rate, local roads and sidewalks get the lowest rating: 46 percent say they are not so good or poor. A third (33%) say local schools are not so good or poor. Blacks (43%) are much more likely than other racial and ethnic groups to express this view about schools.

When Californians are read a list of specific problems, unemployment is by far the biggest concern, with 59 percent calling it a big problem in their community. Far fewer see other issues as big problems: violence and street crime (23%); air pollution and other environment pollutants (23%); lack of places to safely walk, bike, and exercise (13%); and lack of grocery stores and restaurants with healthy food choices (10%). Again, the response to these questions varies widely: Blacks (41%) and Latinos (36%) are far more likely than whites (16%) and Asians (12%) to say violence is a big problem in their community. Strong majorities across regions and most demographic groups say that a lack of grocery stores and restaurants that offer healthy food choices is not much of a problem, but blacks are divided, with 49 percent saying it is a big problem or somewhat of one, and 47 percent saying it is not a problem.

What specific factors contribute a lot to the overall health of people in their communities? Most say good jobs (60%), good public schools (55%) and safe options for walking, biking and getting exercise (54%). Half say safety from violence and street crime and healthy food choices in local grocery stores and restaurants (50% each).

Californians recognize that not all communities are equal. Eight in 10 think lower-income areas of their region have far more (58%) or slightly more (22%) violence and street crime than other areas in their region. Californians also feel lower-income areas in their regions have less access to quality health care (60%); fewer local grocery stores and restaurants offering healthy choices (55%); fewer parks, playgrounds and places to safely walk, bike, and exercise (60%); and worse public schools (59%).

WHERE SHOULD LOCAL GOVERNMENT BOOST EFFORTS? JOB CREATION, SCHOOLS

At a time when the state is considering shifting some revenue and responsibility for services to the local level, how do Californians view the performance of their local governments? Half of adults say their city or local government is doing an excellent (7%) or good (44%) job solving local problems, 30 percent say their city’s performance is not so good, and 10 percent say it is poor. Majorities say their local government is not doing enough to increase job opportunities (68%) or to improve the quality of public schools in their communities (53%).

MORE KEY FINDINGS

Brown job approval dips—page 7Governor Jerry Brown’s job approval rating among California adults is at 34 percent, down from 41 percent in the PPIC survey conducted earlier in January. Today, more are unsure (49%) how to rate his job performance (39% earlier in January). The legislature’s approval rating is similar (24% approve today, 26% earlier in January).

Half say communities play positive role in health—page 17Half of Californians say conditions in their community are having a very positive effect (19%) or somewhat positive effect (30%) on their overall health. Far fewer see a somewhat negative (10%) or very negative 4%) effect, and 34 percent say conditions in their communities have no effect on their health.

Nearly half want to lose weight—page 24Asked about their own weight, 48 percent say they want to lose weight (51% women, 45% men), 45 percent want to stay at their current weight, and only 6 percent want to gain weight.

ABOUT THE SURVEY

The PPIC Statewide Survey has provided policymakers, the media, and the general public with objective, advocacy-free information on the perceptions, opinions, and public policy preferences of California residents since 1998. This survey is supported with funding from The California Endowment as part of a grant to study healthy communities. Findings are based on a telephone survey of 2,504 California adult residents interviewed on landlines and cell phones from January 18–February 1, 2011. Interviews were conducted in English, Spanish, Chinese (Mandarin or Cantonese), Vietnamese, and Korean, according to respondents’ preferences. The sampling error, taking design effects from weighting into consideration, is ±2.9 percent for all adults, ±3.2 percent for the 1,627 registered voters, and ±3.6 percent for the 1,196 likely voters. For more information on methodology, see page 27.

Mark Baldassare is president and CEO of PPIC, where he holds the Arjay and Frances Fearing Miller Chair in Public Policy. He is founder of the PPIC Statewide Survey, which he has directed since 1998.

PPIC is dedicated to informing and improving public policy in California through independent, objective, nonpartisan research on major economic, social, and political issues. The institute was established in 1994 with an endowment from William R. Hewlett. As a private operating foundation, PPIC does not take or support positions on any ballot measure or on any local, state, or federal legislation, nor does it endorse, support, or oppose any political parties or candidates for public office.